Jean-Christophe Fantoni

Testicular natural killer T-cell lymphoma

Abstract  Primary testicular lymphomas account for less than 5% of all testicular neoplasms. Testicular natural killer (NK)/T‐cell lymphomas are exceptional and have a very poor prognosis. We report the case of a 30‐year‐old French Caucasian man with testicular NK/T‐cell lymphoma of the following immunophenotype: CD2+, CD3ɛ+ and CD56+. Despite intensive chemotherapy, the disease progressed rapidly, with death occurring 2 months after diagnosis.

Results of Endoluminal Occlusion of the Inferior Vena Cava During Radical Nephrectomy and Thrombectomy

BACKGROUND The surgical management of renal tumours with thrombi in the inferior vena cava (IVC) has become the gold standard treatment. OBJECTIVE To evaluate endoluminal occlusion of the IVC during radical nephrectomy with either retrohepatic (level II) or suprahepatic (level III) caval tumour thrombus. DESIGN, SETTING, AND PARTICIPANTS From January 2000 to October 2007, 28 consecutive patients with renal cell carcinoma presenting a thrombus level II or III were treated with endoluminal occlusion of the free IVC cranial. SURGICAL PROCEDURE The occlusion balloon was positioned under transesophageal echography (TEE) control through a cavotomy performed at the level of the renal vein ostium. Thrombectomy and radical nephrectomy were then performed. MEASUREMENTS Operative time, perioperative bleeding, and pre- and postoperative complications were assessed. Overall patient survival time, disease-free survival, and development of metastasis were assessed. RESULTS AND LIMITATIONS Caval thrombectomy was performed successfully in all patients. IVC replacement with an expanded polytetrafluoroethylene graft or patch closure after lateral cavectomy was performed in 10 and 4 patients, respectively. Average operative time was 160 min (range: 120-210). There was no perioperative mortality. The complications were one splenectomy and one early thrombosis of the IVC. Mean length of follow-up was 22.1 mo (range: 3-90). There was no local or IVC tumour recurrence. Cause-specific death and metastasis occurred in six (21.4%) and nine patients (32.1%), respectively. Thirteen patients (46.4%) are disease-free. CONCLUSIONS Endoluminal occlusion of the IVC with TEE monitoring for level II and III thrombus avoided a suprahepatic or subdiaphragmatic approach of the IVC. Segmental resection and reconstruction of the IVC could also be performed in case of adherent thrombi.

Prognostic Value of Combined p53 and Survivin in pT1G3 Urothelial Carcinoma of the Bladder

pT1G3 bladder tumors have a high tendency to recur and progress. We evaluated the prognostic values of the depth of submucosal invasion and immunostaining with survivin and p53 in 30 pT1G3 urothelial carcinomas at the first endoscopic resection. The depth of invasion was evaluated toward the muscularis mucosa and measured using a micrometer. Survivin and p53 immunostaining were performed using an automated immunostainer. Of the patients, 19 (63%) had tumor recurrence, 11 (37%) had tumor progression, 10 (33%) had metastatic spread, and 10 (33%) died of the disease. Infiltration of deep lamina propria (pT1b) and a micrometric measure of 1.5 mm or more were associated with an increased risk of tumor local and/or metastatic progression (P = .03 and P = .02, respectively). A combined high expression of survivin (<or=20%) and p53 (<or=50%) was associated with an increased risk of tumor local progression (P = .0007). We showed that combined p53 and survivin immunostaining could be helpful in distinguishing patients with a high risk of tumor progression.

Clear cell papillary renal cell carcinoma is an indolent and low-grade neoplasm with overexpression of cyclin-D1.

Several entities have been individualized recently within the family of renal neoplasms with papillary features. Clear cell papillary renal cell carcinoma (CCPRCC) was first described in patients with end‐stage renal disease, but is also observed in patients with normal renal function. The objective of this study was to document the clinicopathological and immunohistochemical characteristics of CCPRCC, with a special emphasis on cyclin D1 expression.

Rôle pronostique des emboles vasculaires tumoraux dans les tumeurs des voies excrétrices urinaires supérieures : analyse rétrospective monocentrique

OBJECTIVE To analyze the prognostic impact of lymphovascular invasion (LVI) in case of urothelial carcinoma of upper urinary tract (UUT-UC). PATIENTS AND METHODS Retrospective study of 83 consecutive patients treated surgically for UUT-UC between January 1998 and October 2008. Prognostic interest of histopathological factors (stage, grade, LVI, CIS, tumor architecture, location, nodal status and surgical margins) was assessed in univariate and multivariate Cox regression model. Specific survival (SS), recurrence-free survival (RFS) and metastasis-free survival (MFS) were calculated using Kaplan-Meier method and Log-Rank test. RESULTS LVI was observed in 26.5% of patients after histopathologic reviewing. The SS, RFS and MFS at 2 years were 93%, 76% and 96% respectively in group without LVI compared to 40%, 13% and 38% in group with LVI (P<0.001). In univariate analysis, pathological stage, LVI and margin status were predictive of SS (P<0.05). Pathological stage, LVI and surgical margin status were predictive of RFS (P<0.05). LVI, tumor architecture and status of surgical margins were predictive of MFS (P<0.05). LVI was the only independent predictive factor in multivariate analysis for all survival (P=0.002, 0.002 and 0.001 respectively for the SS, RFS and MFS). CONCLUSION LVI was a poor prognostic factor in cases of UUT-UC. This criteria should be routinely sought and included in the pathology report.

Article originalRôle pronostique des emboles vasculaires tumoraux dans les tumeurs des voies excrétrices urinaires supérieures : analyse rétrospective monocentriquePrognostic significance of lymphovascular invasion in upper urinary tract carcinoma: A retrospective monocentric analysis☆

OBJECTIVE To analyze the prognostic impact of lymphovascular invasion (LVI) in case of urothelial carcinoma of upper urinary tract (UUT-UC). PATIENTS AND METHODS Retrospective study of 83 consecutive patients treated surgically for UUT-UC between January 1998 and October 2008. Prognostic interest of histopathological factors (stage, grade, LVI, CIS, tumor architecture, location, nodal status and surgical margins) was assessed in univariate and multivariate Cox regression model. Specific survival (SS), recurrence-free survival (RFS) and metastasis-free survival (MFS) were calculated using Kaplan-Meier method and Log-Rank test. RESULTS LVI was observed in 26.5% of patients after histopathologic reviewing. The SS, RFS and MFS at 2 years were 93%, 76% and 96% respectively in group without LVI compared to 40%, 13% and 38% in group with LVI (P<0.001). In univariate analysis, pathological stage, LVI and margin status were predictive of SS (P<0.05). Pathological stage, LVI and surgical margin status were predictive of RFS (P<0.05). LVI, tumor architecture and status of surgical margins were predictive of MFS (P<0.05). LVI was the only independent predictive factor in multivariate analysis for all survival (P=0.002, 0.002 and 0.001 respectively for the SS, RFS and MFS). CONCLUSION LVI was a poor prognostic factor in cases of UUT-UC. This criteria should be routinely sought and included in the pathology report.

Les cancers de l’ouraque

Urachal cancer is a rare pathology (less than 1% among all bladder tumors) with a poor prognosis for all stages, because of clinical delay leading to a late diagnosis, difficult differential diagnosis with bladder cancer, and no consensus for the treatment, mostly about the chemotherapy for advanced stages, because there are no data from prospective studies. A surgical treatment can be performed for the localized stages, but there are no real guidelines for local relapses and metastatic progression treatment. Those cancers are not radio- or chemosensitive; nevertheless data from fundamental research are missing. As this pathology is really uncommon, there are no clinical studies with targeted therapies. The purpose of this review is to introduce the most important clinical and paraclinical features of those cancers, and the usual treatment performed.

Techniques de réimplantation urétéro-vésicale sur vessie psoïque, avec ou sans lambeau vésicale, par voie cœlioscopique robot-assistée

The National Library of Australia has a relatively small but important collection of digital materials on physical carriers, including both published materials and unpublished manuscripts in digital form. To date, preservation of the Library’s physical format digital collections has been largely hand-crafted, but this approach is insufficient to deal effectively with the volume of material requiring preservation. The Digital Preservation Workflow Project aims to produce a semi-automated, scalable process for transferring data from physical carriers to preservation digital mass storage, helping to mitigate the major risks associated with the physical carriers: deterioration of the media and obsolescence of the technology required to access them. The workflow system, expected to be available to Library staff from June 2008, also aims to minimise the time required for acquisition staff to process relatively standard physical media, while remaining flexible to accommodate special cases when required. The system incorporates a range of primarily open source tools, to undertake processes including media imaging, file identification and metadata extraction. The tools are deployed as services within a service-oriented architecture, with workflow processes that use these services being coordinated within a customised system architecture utilising Java based web services. This approach provides flexibility to add or substitute tools and services as they become available and to simplify interactions with other Library systems.